Resiliency and survival skills among newly homeless adolescents: Implications for future interventions

Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review

BACKGROUND

Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs.

OBJECTIVE

The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing.

METHODS

Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies.

RESULTS

Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services.

CONCLUSIONS

This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.

Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map

Aim

To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health.

Methods

Peer-reviewed articles and conference abstracts published in English between 2012-2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and - in a subsequent screening stage - at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses.

Results

One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]).

Conclusions

Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01934-0.

Resourcefulness of homeless young people who practise sex work in Pakistan: a qualitative study

Background Many homeless young people in Pakistan use sex work as a way to generate income, particularly if they have few other options for work. Because it is highly stigmatised, little attention has been paid to the strategies homeless young people use to practise sex work, and what this suggests about their capacities and strengths. Methods Semi-structured interviews were conducted with 29 homeless young people (aged 16-25years) from Rawalpindi, Pakistan, including nine cisgender heterosexual men, six cisgender heterosexual women, seven cisgender gay men, and seven transgender heterosexual women. Results Participants sought memberships in street-based peer groups where financial gains were contingent on dancing and sex work. To practise their work successfully, participants learned novel skills and mobilised material resources available to them on the streets. Participants talked about how they acquired and benefitted from skills related to beautification, dancing, communication, and sexual services to achieve the necessary standards for entertainment and sex work. Access to material resources like makeup, clothes, rented rooms, mobile phones and condoms made dancing and sex work possible and safer for participants. Conclusions Participants' improvisation with limited resources on the streets has important implications for policy and programs. Showcasing the resourcefulness and capacities of young people encourages a different way of thinking about them. This potential could be utilised in productive ways if they were given the chance to receive mainstream and technical education, better health support and access to the formal job market.

The association between experiencing homelessness in childhood or youth and adult housing stability in Housing First

BACKGROUND

Researchers have pointed out the paucity of research investigating long-term consequences of experiencing homelessness in childhood or youth. Limited research has indicated that the experience of homelessness in childhood or youth is associated with adverse adjustment-related consequences in adulthood. Housing First (HF) has acknowledged effectiveness in improving housing outcomes among adults experiencing homelessness and living with serious mental illness, although some HF clients struggle with maintaining housing. The current study was conducted to examine whether the experience of homelessness in childhood or youth increases the odds of poorer housing stability following entry into high-fidelity HF among adults experiencing serious mental illness and who were formerly homeless.

METHODS

Data were drawn from the active intervention arms of a HF randomized controlled trial in Metro Vancouver, Canada. Participants (n = 297) were referred to the study from service agencies serving adults experiencing homelessness and mental illness between October 2009 and June 2011. The Residential Time-Line Follow-Back Inventory was used to measure housing stability. Least absolute shrinkage and selection operator was used to estimate the association between first experiencing homelessness in childhood or youth and later housing stability as an adult in HF.

RESULTS

Analyses indicated that homelessness in childhood or youth was negatively associated with experiencing housing stability as an adult in HF (aOR = 0.53; 95% CI = 0.31-0.90).

CONCLUSIONS

Further supports are needed within HF to increase housing stability among adult clients who have experienced homelessness in childhood or youth. Asking clients about the age they first experienced homelessness may be of clinical utility upon enrollment in HF and may help identify support needs related to developmental experiences. Results further emphasize the importance of intervening earlier in life in childhood and youth before experiencing homelessness or before it becomes chronic. Findings also contribute to a limited knowledge base regarding the adverse long-term consequences of childhood and youth homelessness.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN57595077 and ISRCTN66721740 . Registered on October 9, 2012.

Development of a Family-Based Mental Health Program for Runaway Adolescents Using an Intervention Mapping Protocol

The mental health and related quality of life of runaway adolescents are global public health issues. As few intervention studies have considered the family contexts of runaway adolescents, we aimed to develop an intervention tailored specifically to the needs of this population using an Intervention Mapping protocol. First, a literature review and interviews with runaway adolescents and youth shelter workers were conducted to create a logic model of the problem. Second, the behavioral and environmental outcomes were set to adapt to stressful situations and enable families to become more resourceful in dealing with family adversity, based on the results of needs assessment. Performance objectives and changeable determinants were also created by reviewing the pertinent theories and studies. Third, theory- and evidence-based methods to influence changes in the determinants were identified. Fourth, we designed an eight-session family-based mental health program incorporating individual and family approaches for runaway adolescents. Fifth, we determined that mental health nurses at community mental health centers linked to youth shelters would serve as the program implementers. Finally, we planned a randomized controlled trial to evaluate the effects of our program on improving runaway adolescents’ mental health status and perceived family functioning.

Prevalence of mental disorders among people who are homeless: An umbrella review

BACKGROUND

Homelessness is a major problem that critically impacts the mental health and well-being of the affected individuals. This umbrella review aimed to evaluate the current evidence on the prevalence of mental disorders among homeless people from evidence-based systematic reviews and meta-analyses.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Joanna Briggs Institute (JBI) methodology for umbrella reviews. We searched 12 major databases and additional sources to identify systematically conducted reviews and meta-analyses reporting the prevalence of mental disorders among homeless populations.

RESULTS

We evaluated 1,277 citations and found 15 reviews meeting our criteria. Most studies were conducted among high-income countries with samples from different age groups. Studies reported high prevalence rates of depressive and anxiety disorders, schizophrenia spectrum and psychotic disorders, substance use disorders, suicidal behavior, bipolar and mood disorders, neurocognitive disorders and other mental disorders among homeless people. Moreover, studies also reported a high burden of co-occurring mental and physical health problems among the homeless experiencing mental disorders.

CONCLUSION

This umbrella review synthesized the current evidence on the epidemiological burden of mental disorders in homelessness. This evidence necessitates advanced research to explore psychosocial and epidemiological correlates and adopt multipronged interventions to prevent, identify and treat mental disorders among homeless populations.

Mental health and psychosocial interventions for children and adolescents in street situations in low- and middle-income countries: A systematic review

This article reviews the available quantitative literature on mental health and psychosocial interventions among children and adolescents in street situations (CASS) in low- and middle-income countries (LAMIC). PRISMA standards for systematic reviews were used to search five databases as well as grey literature. There were four inclusion criteria; studies had to involve a description of an external (i.e. outside of the home) mental health or psychosocial intervention/treatment, must be focused in LAMIC, must be focused on CASS, and must empirically evaluate the effectiveness of the intervention described. A quality assessment tool was used to assess the risk of bias in included articles. Five studies were included. A multidisciplinary care approach was significant in reducing psychological distress, substance use and improving sleeping arrangements (p<0.001, n=400). Residency step programmes were on average 52% successful in reintegrating children back into communities (n=863). Resilience training significantly increased psychological well-being components (p<0.001, n=60). Emotional regulation training had a beneficial improvement in emotional regulation. FORNET (Forensic Offender Rehabilitation Narrative Exposure Therapy) (n=32) reduced the number of self-reported offenses committed [t(19.26)=1.81, p=0.043]. There are not enough credible studies available to develop a firm conclusion on the effectiveness of mental health and psychosocial interventions delivered to CASS in LAMIC. The limited amount of studies, inconsistent outcome measures, interventions and imperfect study designs maintain that this is an area in need of greater attention and research focus.

Resilience, loneliness, and psychological distress among homeless youth

Extant quantitative research on loneliness among homeless youth has grouped loneliness with other elements of psychological distress. The current study seeks to determine if loneliness has a different relationship with resilience than does psychological distress among street youth. Using data from 47 participants, linear regression was conducted. Results indicate that homeless youth experiencing higher psychological distress reported lower resilience scores. However, levels of resilience are not significantly associated with feelings of loneliness when psychological distress was accounted for. This study has implications for how researchers and clinicians conceptualize and address feelings of loneliness among homeless youth.

What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care?

OBJECTIVES

Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor.

METHODS

A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed.

RESULTS

Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context.

CONCLUSION

A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.